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1.
Medicine (Baltimore) ; 98(31): e16545, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374017

RESUMO

Abnormal cervical curvature and cervical disc herniation are closely related to neck pain and should be taken into account before any treatment. However, studies have rarely reported on the correlation between cervical lordosis and cervical disc herniation in patients with neck pain. Therefore, in this study, we collect young neck pain patients with abnormal cervical curvature to evaluate the relationship between cervical lordosis and cervical disc herniation.Three hundred patients below 40 years old with neck pain were enrolled. Patient sex, age, apical vertebra, segment of intervertebral disc protrusionl, sagittal diameter of spinal duramater, saggital diameter of spinal canal, height of disc space were recorded, and the cervical curvature, and degree of cervical spinal cord compression (G/F ratio) were calculated. The change of degree of disc herniation and degree of cervical spinal cord compression were analyzed in different cervical curvature groups. Further more, collected these patients who had improved cervical curvature over a period of time, to compare the changes of degree of disc herniation, G/F ratio, and height of disc space.The median age of patients with kyphosis was lower than those with lordosis and straight cervical spine. The degree of disc herniation was higher in the straight and kyphosis groups compared to the lordosis group. Cervical lordosis was inversely correlated with the degree of disc herniation and positively with G/F ratio. Cervical curvature was significantly affected by sex, age, and the degree of disc herniation. With the improvement of cervical lordotic curvature, the degree of disc herniation decreased and height of disc space increased.The degree of disc herniation and cervical spinal cord compression are inversely correlated to cervical lordosis in young neck pain patients, and the degree of disc herniation and height of disc space can recover with the recovery of cervical lordotic curvature. These findings may indicating a link between cervical curvature and degenerative changes which have important clinical implications.


Assuntos
Deslocamento do Disco Intervertebral/complicações , Lordose/complicações , Cervicalgia/etiologia , Adulto , Vértebras Cervicais/anormalidades , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Radiografia/métodos , Estatísticas não Paramétricas
2.
J Headache Pain ; 20(1): 76, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266456

RESUMO

Unremitting head and neck pain (UHNP) is a commonly encountered phenomenon in Headache Medicine and may be seen in the setting of many well-defined headache types. The prevalence of UHNP is not clear, and establishing the presence of UHNP may require careful questioning at repeated patient visits. The cause of UHNP in some patients may be compression of the lesser and greater occipital nerves by the posterior cervical muscles and their fascial attachments at the occipital ridge with subsequent local perineural inflammation. The resulting pain is typically in the sub-occipital and occipital location, and, via anatomic connections between extracranial and intracranial nerves, may radiate frontally to trigeminal-innervated areas of the head. Migraine-like features of photophobia and nausea may occur with frontal radiation. Occipital allodynia is common, as is spasm of the cervical muscles. Patients with UHNP may comprise a subgroup of Chronic Migraine, as well as of Chronic Tension-Type Headache, New Daily Persistent Headache and Cervicogenic Headache. Centrally acting membrane-stabilizing agents, which are often ineffective for CM, are similarly generally ineffective for UHNP. Extracranially-directed treatments such as occipital nerve blocks, cervical trigger point injections, botulinum toxin and monoclonal antibodies directed at calcitonin gene related peptide, which act primarily in the periphery, may provide more substantial relief for UHNP; additionally, decompression of the occipital nerves from muscular and fascial compression is effective for some patients, and may result in enduring pain relief. Further study is needed to determine the prevalence of UHNP, and to understand the role of occipital nerve compression in UHNP and of occipital nerve decompression surgery in chronic head and neck pain.


Assuntos
Transtornos da Cefaleia/etiologia , Cervicalgia/etiologia , Síndromes de Compressão Nervosa/complicações , Transtornos da Cefaleia/terapia , Humanos , Cervicalgia/terapia , Bloqueio Nervoso/métodos , Síndromes de Compressão Nervosa/terapia , Nervos Espinhais
3.
Cancer Radiother ; 23(4): 312-315, 2019 Jul.
Artigo em Francês | MEDLINE | ID: mdl-31147172

RESUMO

PURPOSE: To report the results of Botulinum Toxin A (BTA) for radiation-induced head and neck pain. MATERIALS AND METHODS: This single-center retrospective study included all the patients treated at our institution with botulinum toxin A injections for radiation-induced head and neck pain between 2006 and 2017. Pain was evaluated by each patient on a visual analogue scale (VAS) (between 0 and 10) before, and 1 month after the injection. RESULTS: Sixteen patients were included in this series. The mean value of the pain was 8.5 before and 8 after the first injection. The difference was statistically significant (p<0.01). Major response occurred in 15 patients (VAS≤3 after BTA) and complete response in 11 patients (VAS=0 after BTA). CONCLUSION: Botulinum toxin is an effective treatment for radiation-induced head and neck pain.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Cervicalgia/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Radioterapia/efeitos adversos , Adulto , Idoso , Eletromiografia , Feminino , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Estudos Retrospectivos , Escala Visual Analógica
4.
J Forensic Leg Med ; 66: 1-3, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31173945

RESUMO

Non-fatal strangulation is a very common but often underestimated cause of severe injury. In this case, a woman experienced several episodes of manual strangulation in an episode of domestic violence which involved loss of consciousness, confusion and neck pain, particularly over the trachea. CT angiogram of the neck showed a small perforation of the trachea at the level of the thoracic inlet. The prevalence of non-fatal strangulation in the Australian general population is unknown, but a study in Western Australia measured a prevalence of 7.4% of women presenting to a sexual assault service. A systematic review analysing data from 9 countries in North America and Europe, estimated a lifetime prevalence by an intimate partner of between 3.0% and 9.7% of all women (1). US data suggests that of those experiencing intimate partner violence, prevalence ranges from 27 to 68% (2, 3). This article considers the limited science known about the injuries sustained from non-fatal manual strangulation, much of which is extrapolated from case reports in the literature.


Assuntos
Asfixia/etiologia , Violência Doméstica , Lesões do Pescoço/complicações , Traqueia/lesões , Confusão/etiologia , Enfisema/diagnóstico por imagem , Feminino , Humanos , Cervicalgia/etiologia , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagem , Inconsciência/etiologia , Adulto Jovem
5.
Ann R Coll Surg Engl ; 101(7): e150-e153, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31232606

RESUMO

Abscess of the anterior belly of the digastric muscle has not been previously described and could pose a diagnostic and interventional dilemma. This case summarises the clinical, microbiological, radiological and surgical issues encountered and suggests learning points for clinicians posed with similar presentations. We recommend timely assessment by an appropriately trained clinician in either ear, nose and throat or oral and maxillofacial surgery, admission to a closely observable environment with airway-trained nursing staff and with potential for escalation to high dependency or intensive care in the event of airway compromise, as well as early involvement of an anaesthetist. Multimodality imaging should be performed to identify and localise an abscess collection or phlegmon, including an orthopantomogram in anticipation of odontogenic source and dental extraction as a definitive intervention. Surgical intervention for the abscess collection should be considered with consideration of the important neurovascular structures in this region.


Assuntos
Abscesso/diagnóstico , Músculos do Pescoço/diagnóstico por imagem , Abscesso/complicações , Abscesso/terapia , Administração Intravenosa , Antibacterianos/administração & dosagem , Celulite (Flegmão)/etiologia , Transtornos de Deglutição/etiologia , Diagnóstico Diferencial , Humanos , Angina de Ludwig/diagnóstico , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Paracentese , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
Medicine (Baltimore) ; 98(20): e15690, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096509

RESUMO

RATIONALE: Langerhans cell histiocytosis (LCH) involving adult cervical vertebrae is relatively rare clinically. PATIENT CONCERNS: An 18-year-old male patient exhibited a 1-month history of neck pain, restricted neck mobility, and numbness and weakness of both upper limbs. The patient reported no pain at other sites, exhibited no fever or night sweats, and was unable to recall any recent injury. DIAGNOSES: On the basis of the radiological features of the lesion and laboratory tests, there was a high possibility that the patient had a tuberculosis lesion. Postoperative GeneXpert and Mycobacterium tuberculosis (MTB) culture results showed MTB negative. Postoperative pathological results showed: (Cervical 4 vertebrae) LCH. INTERVENTIONS: Our department did an anterior approach operation. The patient was treated with prednisone combined with vincristine after operation. OUTCOMES: The patient was discharged from the hospital with complete remission of cervical pain and rapid relief of neurological symptoms. LESSONS: Computed tomography-guided biopsy of lesion tissue must be performed when a suspected infection occurs in young patients. If possible, the lesion tissue obtained during the operation should be cultured and pathologically examined for early diagnosis.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Histiocitose de Células de Langerhans/diagnóstico , Tuberculose Osteoarticular/diagnóstico , Adolescente , Vértebras Cervicais/cirurgia , Diagnóstico Diferencial , Histiocitose de Células de Langerhans/diagnóstico por imagem , Histiocitose de Células de Langerhans/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Cervicalgia/etiologia , Tomografia Computadorizada por Raios X , Tuberculose Osteoarticular/diagnóstico por imagem , Tuberculose Osteoarticular/cirurgia
8.
Medicine (Baltimore) ; 98(18): e15476, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045829

RESUMO

RATIONALE: Autoimmune thyroid diseases (ATDs) seldom affect intracranial pressure. Here, we describe a case of spontaneous intracranial hypotension (SIH) related to Hashimoto's thyroiditis (HT), which has never been previously published. PATIENT CONCERNS: A 54-year-old woman was admitted to our hospital due to sudden-onset postural headache, neck pain stiffness, visual blurring, nausea and vomiting. The headache was aggravated when the patient sat or stood up yet rapidly resolved within 1 minute after recumbency. DIAGNOSIS: The patient had a grade 1a diffusely palpable thyroid gland and the laboratory report revealed elevated titers of anti-thyroid antibodies, a diagnosis of HT was established. Gadolinium-enhanced magnetic resonance imaging exhibited dilatation of the venous sinuses, obvious diffuse pachymeningeal enhancement, and narrowing of the ventricular system, combined with the lumbar puncture pressure was 60 mmH20 in the lateral recumbent position, and a diagnosis of SIH was eatablished. INTERVENTIONS: The patient was placed on strict bed rest and hydrated for 15 days. OUTCOMES: The headache was gradually relieved, a follow-up at 1 month after discharge revealed that the patient could stand and function normally. LESSONS: SIH can be related to ATD.


Assuntos
Doença de Hashimoto/complicações , Cefaleia/etiologia , Hipotensão Intracraniana/etiologia , Cervicalgia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade
9.
No Shinkei Geka ; 47(4): 419-427, 2019 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-31061226

RESUMO

OBJECTIVE: Anterior condylar confluent dural arteriovenous fistula(ACC-dAVF)constitutes 3.7% of the total dAVF cases reported and has been regarded as a rare disease in the past. However, encounters with this disease are increasing due to MRI and awareness of this condition. The symptoms of this disease have been reported as tinnitus(75%), ocular symptoms(31%), sublingual nerve palsy(12%), spinal cord symptoms(11%), and intracranial bleeding(5%). Here, we report our identification of a case of ACC-dAVF, which is different from conventional reports, and the associated findings. CASE PRESENTATIONS: We experienced a series of 3 cases of ACC-dAVF with the chief complaint of neck pain. The symptoms in all three patients disappeared after transvenous embolization. Based on the pathophysiology of cervical pain, we presumed that the blood flow dynamics of the odontoid arcade was involved. As expected, after the blood flow near the transverse ligament of the atlas was normalized the symptoms disappeared. CONCLUSION: We could not find previous reports of ACC-dAVF where the main symptom was cervical pain. We report the possibility of a mechanism of dAVF different from those reported previously.


Assuntos
Malformações Vasculares do Sistema Nervoso Central , Embolização Terapêutica , Zumbido , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/terapia , Humanos , Imagem por Ressonância Magnética , Cervicalgia/etiologia , Zumbido/etiologia
12.
J Orthop Surg Res ; 14(1): 94, 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947714

RESUMO

OBJECTIVES: The aim of this study was to explore the prevalence and risk factors for axial neck pain in patients undergoing multilevel anterior cervical decompression with fusion surgery. METHODS: In this study, 88 patients, who underwent multilevel anterior cervical decompression with fusion surgery from January 2012 to January 2017, were retrospectively reviewed. Based on the postoperative axial neck pain, the patients were classified into two groups: axial pain group and no axial pain group. The patients were followed up 3 weeks, 3 months, and 1 year after cervical anterior surgery for the early- and long-term clinical evaluation. The possible effect factors included demographic variables (age, sex, BMI, smoking, drinking, heart disease, hypertension, diabetes, preoperative kyphosis, preoperative axial neck pain, preoperative JOA scores, and ODI) and surgery-related variables (surgical option, vertebral lesions, spinal canal stenosis rate, superior fusion segment, presence of intramedullary high signal intensity). RESULTS: The prevalence of axial neck pain was 27.3% (24 cases of 88). Our results showed that preoperative axial neck pain (62% vs 23%, P < 0.001) and preoperative kyphosis (42% vs 21.9%, P < 0.001) were risk factors for axial pain after multilevel anterior cervical surgery. Additionally, for patients with preoperative cervical kyphosis, compared to no axial pain group, the axial neck group was significantly more likely to exist a higher preoperative angle of C2-7 (13.31 ± 2.33 vs 7.33 ± 2.56, P < 0.001) and a higher correction range for kyphosis (20.24 ± 4.12 vs 12.34 ± 3.12, P < 0.001). However, for all the patients with postoperative axial symptoms, the improvement rate of axial pain was significantly higher for patients without cervical kyphosis at the early-term follow-up (3 weeks) (P = 0.032), no significant differences were found at the medium-term (P = 0.554) and long-term follow-up (P = 0.902), and improvements of clinical symptom have no obvious difference at the last follow-up. CONCLUSIONS: Overall, preoperative axial neck pain and kyphosis could predict axial neck pain for patients undergoing multilevel anterior cervical decompression with fusion surgery, and recovery of cervical kyphosis may contribute to the long-term recovery of neural function, but may also suffer from risk of short-term axial pain, which could be reduced through moderate cervical curvature recovery.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Cervicalgia/etiologia , Dor Pós-Operatória/etiologia , Fusão Vertebral/efeitos adversos , Idoso , Vértebras Cervicais/diagnóstico por imagem , Descompressão Cirúrgica/métodos , Feminino , Seguimentos , Humanos , Cifose/complicações , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico por imagem , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico por imagem , Radiografia , Estudos Retrospectivos , Fatores de Risco , Fusão Vertebral/métodos , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/cirurgia
13.
BMJ Case Rep ; 12(3)2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30898959

RESUMO

We report the case of a 59-year-old Arab woman who was presented with acute onset of neck pain followed by quadriparesis, paraesthesias of lower limbs and incontinence of urine. Examination revealed asymmetric sensorimotor quadriparesis with sensory level at T1, establishing a clinical diagnosis of transverse myelitis. Cervical and thoracic spinal MRI showed enhancing T2/fluid attenuated inversion recovery (FLAIR) hyperintense lesion extending from C4 to C7 level in addition to long-segment lesion extending the whole of the spinal cord. She was known to have rheumatoid arthritis for the past 20 years and has been on etanercept for the past 8 years and methotrexate since past 3 years. Etanercept was stopped and she was treated with methylprednisolone followed by oral steroids and physiotherapy with which she had near complete recovery.


Assuntos
Antirreumáticos/efeitos adversos , Etanercepte/efeitos adversos , Mielite Transversa/induzido quimicamente , Anti-Inflamatórios/administração & dosagem , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Medula Cervical/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Mielite Transversa/tratamento farmacológico , Cervicalgia/etiologia , Prednisolona/administração & dosagem , Prednisolona/análogos & derivados
15.
J Electromyogr Kinesiol ; 46: 49-54, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30921651

RESUMO

Bipolar surface EMG (sEMG) signals of the trapezius muscles bilaterally were recorded continuously with a frequency of 800 Hz during full-shift field-work by a four-channel portable data logger. After recordings of 60 forest machine operators in Finland, Norway and Sweden, we discovered erroneous data. In short of any available procedure to handle these data, a method was developed to automatically discard erroneous data in the raw data reading files (Discarding Erroneous EPOchs (DESEPO) method. The DESEPO method automatically identifies, discards and adjusts the use of signal disturbances in order to achieve the best possible data use. An epoch is a 0.1 s period of raw sEMG signals and makes the basis for the RMS calculations. If erroneous signals constitute more than 30% of the epoch signals, this classifies for discharge of the present epoch. Non-valid epochs have been discarded, as well as all the subsequent epochs. The valid data for further analyses using the automatic detection resulted in an increase of acceptable data from an average of 2.15-6.5 h per day. The combination of long-term full-shift recordings and automatic data reduction procedures made it possible to use large amount of data otherwise discarded for further analyses.


Assuntos
Eletromiografia , Cervicalgia/etiologia , Traumatismos Ocupacionais/etiologia , Processamento de Sinais Assistido por Computador , Músculos Superficiais do Dorso/fisiopatologia , Adulto , Antropometria , Artefatos , Coleta de Dados , Interpretação Estatística de Dados , Processamento Eletrônico de Dados , Finlândia , Agricultura Florestal , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Noruega , Suécia
17.
Acta Neurochir Suppl ; 125: 63-70, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30610304

RESUMO

BACKGROUND: This paper reviews an experience of surgically treating ossification of the posterior longitudinal ligament (OPLL) with fixation of the involved spinal segments alone, without resorting to any bony or soft tissue decompression or attempts at direct resection of the OPLL. While in the early part of the experience, stabilization of only the involved subaxial cervical spinal segments was done, in the later part of the experience, atlantoaxial fixation was included in the multisegmental spinal fixation construct. This treatment is based on the understanding that spinal instability that includes atlantoaxial instability forms the nodal point of the pathogenesis and development of OPLL, and maturation of the presenting clinical symptoms. MATERIALS AND METHODS: Twenty-nine patients were treated in this series. There were 28 males and one female, and their ages ranged from 28 to 75 years (average 57 years). All patients presented with symptoms of neck pain, and progressive and disabling myelopathy-related quadriparesis. In the early part of the series (from 2012 to 2014), 14 patients underwent multilevel subaxial cervical spinal fixation by a transarticular technique of facetal fixation. After November 2014, atlantoaxial lateral mass fixation was included in the fixation construct in the subsequent 15 patients. Clinical assessments were done using a visual analogue scale (VAS), the Japanese Orthopaedic Association (JOA) scale and Goel's clinical grading scale. RESULTS: All patients' clinical symptoms improved in the immediate postoperative period, and the improvement was sustained and progressive in 28 patients. CONCLUSION: Atlantoaxial and subaxial spinal instability seems to be the nodal pathogenetic factor in OPLL. Only stabilization of spinal segments that includes the atlantoaxial joint can provide a safe, simple and rational form of treatment.


Assuntos
Articulação Atlantoaxial/cirurgia , Vértebras Cervicais/cirurgia , Instabilidade Articular/cirurgia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Articulação Atlantoaxial/fisiopatologia , Vértebras Cervicais/fisiopatologia , Feminino , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Cervicalgia/cirurgia , Ossificação do Ligamento Longitudinal Posterior/complicações , Ossificação do Ligamento Longitudinal Posterior/fisiopatologia , Quadriplegia/etiologia , Quadriplegia/cirurgia , Estudos Retrospectivos , Base do Crânio/fisiopatologia , Base do Crânio/cirurgia , Resultado do Tratamento
18.
Acta Neurochir Suppl ; 125: 365-367, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30610346

RESUMO

Occipital nerve stimulation (ONS) is electric stimulation of the distal branches of the greater occipital nerve by cylindrical or paddle leads implanted in subcutaneous occipital tissue. This surgical option has emerged as a promising treatment for different types of disabling medical refractory headache and recently also for residual occipital and nuchal pain after previous occipitocervical fusion. The mechanisms of action have not yet been clearly explained: electrical stimulation of the occipital nerve has both peripheral and central effects on the nervous system, which may modulate nociception. ONS is a well-tolerated and safe procedure in comparison with other invasive modalities of treatment. Lead migration/dislodgement is a common complication, but use of new surgical techniques and leads may reduce the rate of this complication.


Assuntos
Terapia por Estimulação Elétrica , Dor Intratável/cirurgia , Dor Pós-Operatória/cirurgia , Fusão Vertebral/efeitos adversos , Nervos Espinhais/cirurgia , Terapia por Estimulação Elétrica/instrumentação , Eletrodos Implantados , Transtornos da Cefaleia/etiologia , Transtornos da Cefaleia/cirurgia , Humanos , Cervicalgia/etiologia , Cervicalgia/cirurgia , Dor Intratável/etiologia , Dor Pós-Operatória/etiologia
19.
Intern Med ; 58(9): 1355-1360, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30626815

RESUMO

A 26-year-old woman with Takayasu's arteritis (TAK) experienced back and neck pain during tocilizumab (TCZ) treatment. The levels of C-reactive protein were normal, and ultrasonography revealed no significant changes. Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) showed signal enhancement in the walls of several arteries. Contrast computed tomography showed arterial inflammation in the same lesion. After increasing the dose of prednisolone and TCZ, all signal enhancements decreased and continued to decrease, as observed on days 76 and 132. Thus, DWIBS may be a novel imaging modality for assessing the disease activity of TAK, particularly during follow-up.


Assuntos
Anti-Inflamatórios/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Prednisolona/administração & dosagem , Arterite de Takayasu/patologia , Adulto , Dor nas Costas/etiologia , Proteína C-Reativa/metabolismo , Artéria Carótida Primitiva , Estenose das Carótidas/etiologia , Estenose das Carótidas/patologia , Angiografia por Tomografia Computadorizada , Relação Dose-Resposta a Droga , Feminino , Humanos , Infusões Intravenosas , Imagem por Ressonância Magnética/métodos , Imagem Multimodal , Cervicalgia/etiologia , Recidiva , Síndrome do Roubo Subclávio/etiologia , Síndrome do Roubo Subclávio/patologia , Arterite de Takayasu/tratamento farmacológico , Ultrassonografia , Imagem Corporal Total/métodos
20.
J Neurol ; 266(2): 298-305, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30542949

RESUMO

OBJECTIVE: To analyze the characteristics and relative factors of headache and neck pain due to cervicocerebral artery dissection (CAD). METHODS: A total of 146 consecutive patients with CAD in Zhengzhou, China (2010-2017) were observed and registered prospectively. There were 60 (60/146) cases who complained of headache and neck pain, and we analyzed the characteristics of pain according to their clinical features. For the 130 (130/146) patients with complete clinical laboratory data, they were divided into two groups according to pain, and the relative factors of pain were analyzed. RESULTS: The headache and neck pain in 60 CAD patients was mostly acute onset (98.3%), 70.6% (12/17) of patients with anterior circulation dissection and 88.4% (38/43) of patients with posterior circulation dissection complained of moderate to severe pain. 41.2% (7/17) of patients with anterior circulation dissection had temporal pain, while 46.5% (20/43) of the patients with posterior circulation dissection had occipital pain. There were 23.5% (4/17) and 32.6% (14/43) of patients with anterior and posterior circulation dissection complained of throbbing pain, respectively, 23.5% (4/17) and 20.9% (9/43) of patients with anterior and posterior circulation dissection complained of pulsating pain. The pain could occur in the ipsilateral (40.0%), bilateral (52.7%), or contralateral (7.3%) sites of the dissection. In the 130 patients, there were 56 cases (43.1%) in the pain group, and 74 cases (56.9%) in the non-pain group. Multivariate logistic regression analysis showed that female gender (OR 4.01, 95% CI 1.63-9.85, P = 0.002), posterior circulation (OR 3.18, 95% CI 1.39-7.28, P = 0.006), history of headache (OR 4.72, 95% CI 1.08-20.52, P = 0.039), and low-density lipoprotein less than 1.8 mmol/L (OR 2.90, 95% CI 1.15-7.34, P = 0.025) were risk factors of the occurrence of the pain related to CAD. CONCLUSION: The headache and neck pain caused by CAD is a moderate to severe pain occurring suddenly. The pain nature may be diverse but mostly like throbbing and pulsating. When the dissected artery is located in the posterior circulation, the pain is mostly in the occipital region, and mostly in the temporal region when the dissected artery is located in the anterior circulation. The pain can occur in ipsilateral, bilateral, or contralateral of the dissection. In addition, several factors might contribute to the occurrence of headache and neck pain.


Assuntos
Cefaleia , Doenças Arteriais Intracranianas , Cervicalgia , Dissecação da Artéria Vertebral , Adulto , Idoso , Angiografia Cerebral , Feminino , Cefaleia/diagnóstico por imagem , Cefaleia/etiologia , Cefaleia/fisiopatologia , Humanos , Doenças Arteriais Intracranianas/complicações , Doenças Arteriais Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico por imagem , Cervicalgia/etiologia , Cervicalgia/fisiopatologia , Estudos Prospectivos , Dissecação da Artéria Vertebral/complicações , Dissecação da Artéria Vertebral/diagnóstico por imagem
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